We inspected this service on 22 and 23 October, with follow up calls to people, relatives and staff taking place up to 15 November 2018. This was an unannounced inspection. At our last inspection published in December 2015, the service was rated good overall. However, at this inspection we found the service was not rated as good overall and there were breaches of regulation. You can see what action we told the provider to take at the back of this report.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to people with a physical or sensory disability, older adults, younger adults, those living with mental health issues or dementia or people who may have a learning disability. At the time of our inspection there were 217 people using the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were not always protected from potential abuse and things were not always learnt when things went wrong as timely action was not always taken. Systems were not always in place to monitor trends in incidents and systems in place were not always effective at improving people’s experience of their care.

Notifications were not always submitted, as required by law.

Risks were not always assessed and planned for as details of risks to people and staff were not always detailed in people’s care plans. We could not be sure that people were always receiving their medicines safely as instructions were not always followed, or were not always available.

People were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act (MCA) 2005 were not always being followed.

Staff were recruited safely; however, there was mixed feedback about staffing levels and not all calls were on time, but action was taken to address this.

Staff received an induction and ongoing training, however this was not always effective or updated in a timely way. Staff also had mixed feedback about how supported they felt.

Staff followed infections control measures to help keep people healthy. People were also supported to have a diet of their choice and were supported to access other health professionals when necessary.

People and relatives felt staff were kind and caring and treated with dignity and respect when being supported. People were encouraged to be independent and could make choices about their care.

People were involved in developing their care plans and people and relatives were involved in reviews which contained personalised details about people’s routines.

People knew how to complain and felt able to. We saw complaints were investigated and responded to. People and relatives were able to feedback about their care and staff were able to attend meetings to discuss changes with the service. Staff felt the manager was approachable.

End of life care for people had been considered, although few people required this at the time of the inspection.

We have made one recommendation in the main body of the report to recommend steps are taken to ensure people with all protected characteristics are actively supported and protected, when necessary. We also identified two breaches of regulation and you can see the action that we have asked the provider to take at the end of this report.

The inspection took place on 3 November 2015 and was announced. We told the provider two days before our visit that we would be coming. We did this because we needed to be sure that the registered manager would be in. At our previous inspection in December 2014 we judged the service as Requiring Improvement in medicine management, staff training and support, and involving people in decision making about their care and support needs. This inspection was to check that improvements had been made.

Radis Community Care (Stoke-on-Trent)) provides care and support to people in their own homes and in the Newcastle-under-Lyme and Stoke-on-Trent areas. At the time of this inspection 209 people used the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to ensure that people who used the service were protected from the risk of abuse. The registered manager and staff had received training in safeguarding adults from abuse and were aware of the procedures to follow if they suspected that someone was at risk of harm.

People were offered support in a way that upheld their dignity and promoted their independence. Care plans were written in a personalised way based on the needs of the person concerned.

People were supported at mealtimes to have food and drinks of their choice.

Recruitment for additional care staff was on-going to eliminate the need for agency workers.

The provider had a recruitment process in place. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People who used the service told us they received their medicines in the way they had been prescribed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so. The provider consistently follow the guidance of the MCA and ensure that people who required support to make decisions were supported and that decisions were lawfully made in people’s best interests.

Complaints and concerns were looked at by the registered manager in line with the procedures and action was taken to reduce the risk of recurrence.

People told us that staff were kind, thoughtful and caring. People were fully involved with planning and reviewing their care and support needs.

People told us they felt well supported by the management and staff worked well as a team. The safety and quality of the service was regularly checked and improvements made when necessary.

During the last inspection on 28 January 2013 we found that the provider was not meeting some of the essential standards of quality and safety. At this inspection we found that there had been some improvements made to ensure that people who used the service received the required standard of care.

We spoke to people who used the service who were happy with the care provided. One person told us, “The carers are good they treat me well”. Another person told us, “I can’t fault the service I get”.

We found there had been some improvements in the way people’s care was planned and delivered. Further improvements were required to ensure that people who used the service received care that was planned and delivered to protect their safety and welfare.

Staff we spoke with told us that they had received recent update training for medication and manual handling. The provider had made some improvements to the support and training that staff received, but further improvements were required to ensure that all staff were trained to the appropriate standards.

The provider had made some improvements to the systems in place to assess and monitor the quality of the service provided. These systems were still being implemented and further improvements were needed to ensure that these were effective and sustainable.

We saw that the provider had made improvements to their systems to notify us of allegations of abuse that had occurred to people who used the service.

During this inspection we found that improvements had been made in how people’s views and experiences were used in the planning and delivery of their care.

We found that people were not consistently getting the care and support that they required. Some people told us they had experienced times when care staff had not turned up to provide their care. This resulted in people not receiving the medicines and food they required.

We saw there was a lack of staff training. This meant that many of the staff had not received the training required to enable them to care for people in a safe and appropriate manner.

We found that there were ineffective systems in place to manage the service. This meant the provider was not adequately assessing and monitoring the quality of the service and problems with quality were not being identified or addressed.

We found that the provider was still not notifying us of allegations of abuse that had occurred as a consequence of providing a service to people. This meant we were unaware of referrals and investigations that had been undertaken.

This inspection was part of our scheduled programme. It was an unannounced visit so the service did not know we were going.

Most of the people we spoke with had regular care workers and were pleased with the care they provided. Most people were also satisfied with the time they received their care. Comments included: "Excellent" and, "Very kind". A few of the people we spoke with said that they did not know who was going to provide their care and that sometimes their visits were late or quite early.

Some people were not getting their visits as planned as the service told us that since March 2012 there had been 35 visits that had not been provided. This could mean that some people could have been placed at risk of harm. The provider had put in plans to try and address this issue.

The provider completed an assessment of people's needs before the care started. People had plans of care. These identified the tasks that were needed but gave limited information about how people wanted their care providing. One person told us that they did not have regular care workers and had to tell care workers what care they needed to provide. Person centred plans of care would provide care workers with all the information they needed to provide people with the care they needed. This is particularly important when providing care to people with dementia care needs.

Most of the people we spoke with were complimentary about their regular care worker and felt they knew their needs. However we saw that some care workers did not have training in medical conditions when they were providing care in these areas. We also saw that staff were not being supported in relation to their responsiblilities, to provide care safely and to an appropriate standard. Staff were not receiving supervision and the appraisal system had lapsed.

People we spoke with said they felt safe and that care workers were kind. Staff had received training and knew how to identify and report incidents of abuse.

The provider had a number of systems in place to review and monitor the service people received although these processes were not being followed. Reviews of plans of care and risk assessments were not up to date and checks on staff practices were not occurring. Some telephone calls to check the quality of the service were taking place.

The provider had a complaints procedure in place and although there had been a significant number these were being responded to and actions taken to address the issues.

The provider was aware of the issues it needed to address and had put an action plan in place identifying how it would address the issues.

We completed an announced inspection at Radis Community Care (Stoke-on-Trent) on 17 and 18 December 2014. At the last inspection on 28 May 2013, we asked the provider to take action to make improvements to the assessment and recording of people’s preferences, the training and support for staff and how they monitored the quality of the service provided. We found that some of these actions had been completed.

Radis Community Care (Stoke-on-Trent) are registered to provide personal care. People are supported with their personal care needs to enable them to live in their own homes and promote their independence. At the time of the inspection the service supported approximately 277 people in the Staffordshire and Stoke-on-Trent area.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were not in place to ensure that people received their medicines safely because records did not contain sufficient information.

Systems were in place to monitor the quality of the service provided, but some improvements were needed to ensure that the monitoring of the service was effective.

People’s risks were assessed. We saw that staff carried out support in a safe way whilst they ensured that people’s independence was promoted. However some improvements were needed that ensured people’s risks were reviewed.

There were sufficient staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels against the needs of people who used the service.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs. Staff told us that they felt supported by the registered manager.

Some people who used the service were unable to make certain decisions about their care. We found that mental capacity assessments had not always been carried out and consent to care and treatments had not been recorded appropriately in line with the Mental Capacity Act 2005.

We saw that staff treated people with compassion, dignity and respect. Staff listened to people and encouraged them to make decisions about their care.

People told us they knew how to complain and the provider had an effective system in place to investigate and respond to complaints.

The provider promoted an open culture. Staff told us that the management were approachable and that they listened to them.